Anterior–Posterior Persistent Fetal Vasculature With Multiple Stalks: Persistent Vasa Hyaloidea Propria

An 8-week-old boy referred for an abnormal pupil was found to have an atypical presentation of persistent fetal vasculature (PFV) with multiple vascular stalks. Examination under anesthesia with fluorescein angiography (FA) revealed 2 perfused persistent hyaloid vessels, one extending from the optic disc and another from the inferonasal retina. These vessels meet anteriorly to form a vascular network at the lens, which is the remnant of the tunica vasculosa lentis. Although the posterior portion of PFV typically presents as a single stalk attached at the optic disc, this case features an atypical presentation of 2 distinct vascular stalks, which may expand our understanding of ocular development and pathogenesis of PFV. We hypothesize that the aberrant additional stalk may represent failure of the vasa hyaloidea propria (tributaries of the hyaloid artery) to regress.